We all need to talk, but not everyone can afford to

Talking therapies offer a lifeline for people with mental health problems – but for many are prohibitively expensive. Do you need to be rich in order to heal?

Private therapy costs an average £120 a month, with some people paying over £400 – that’s big money. There are options in Bristol if you’re skint and need mental health support, but it’s one of the city’s most underfunded service areas. The council spends just 1.8% of its health budget on mental health.

“It’s a national disgrace there isn’t sufficient investment into mental health services,” says Kyra Bond, director of Womankind, a Bristol-based charity offering women free therapy for up to six months. Last year its helpline took 4,500 support requests and 420 people were assisted face-to-face. “We want to offer more, but can’t,” says Bond.

An endless wait

Locally, the NHS funds Bristol Wellbeing Therapies (formerly LIFT Psychology), which gets 1,000 monthly referrals from individuals and GPs. It offers six to 12 sessions of counselling, cognitive behavioural therapy (CBT) or eye-movement desensitisation reprogramming (EMDR).

In August 2015 I referred myself for support with post-traumatic stress. A month after requesting an appointment, I had a phone assessment. Three months later I had my initial appointment. Despite appealing the decision, after three sessions I was discharged without any referral to another service. This was based on the fact that I am healing “complex childhood trauma” and that 12 sessions are not only not enough, but could also be destabilising.

This spring I tried again. My GP made an urgent referral because I was struggling with suicidal thoughts and feelings. I waited three weeks for an assessment and the therapist ended the call by saying, “I will talk with my team and get back to you about what we can offer. I want to warn you that we still might not be able to offer you any help.”

Six weeks later, I was told they’d made the same decision as before. I have heard countless stories of similar problems with the NHS and/or Bristol Wellbeing Therapies.

In 2011 the government released a report, No Health Without Mental Health. ‘No decision about me without me’ was its governing principle. It committed to investing £400 million into psychological therapies, announcing that by 2014/5 “every adult that requires it should have access to psychological therapies to treat anxiety disorders or depression”.

“The report didn’t deliver what it was supposed to. Nobody was allocated to follow it up and ensure that what was promised came to fruition,” explains Rezina Hakim, national campaigns manager of mental health charity, Mind. The report was scrapped and two others written in its place. A new Mental Health Taskforce was also formed, comprising leading charities and service users; they created and presented the NHS with a comprehensive report in February 2016. In it, they show that the NHS is still meeting only 15% of the need for talking therapy within the UK, and aiming to increase that to 25% by 2020/21. So what about the other 75% of people?

One size doesn’t fit all

It’s also a question of the type of support on offer. The short-term model the NHS uses can – reflecting the advice I received – make things worse for some people. There need to be alternatives for people who don’t fit the NHS’ “one size fits all model”, explains Alexander*, a Bristol trauma specialist. “Mental health doesn’t work like that – what each of us needs is so different. Thousands of people are falling through the gaps”. It is possible to get long-term psychotherapy on the NHS, but only in cases of severe mental health challenges – and even then it’s incredibly difficult.

A few years ago, Jake* referred himself to the Cruse bereavement service after his father died. “I waited six months to be seen,” he says. “By the time a space became available, I wasn’t in the right place to be going – so much can change in your mental health in six months”. This is the story across the board: Mind’s 2013 We Still Need to Talk report showed one in 10 people waiting over a year for an appointment, with just half being seen within four months.

In April 2016, however, thanks to the Mental Health Taskforce, the government introduced the first ever waiting times standards, investing £80 million into improving accessibility. From now on, 75% of people have to have a first appointment within six weeks of referral and 95% within 18 weeks. “We’ll still hear of people who aren’t seen within that time,” says Hakim, “but it’s a positive step”.

Sliding scales and steps forward

Free services reliant on statutory grants and funding are left vulnerable to government cuts and the challenge of continuous fundraising. Of solutions independent from grants, sliding-scale systems are the most popular and sustainable. Therapists charge higher rates to those who can afford it and lower rates or nothing to low-income or unwaged people. The Free Psychotherapy Network (FPN) of UK therapists offers free or low cost therapy, encouraging the spread of more sliding-scale and pro-bono therapy clinics.

Therapists must earn a living and feel respected for what they do, but some choose to earn less than if they were running a full-cost private practice. “Our therapists earn less, but have a passion,” explains Bond.

Healing shouldn’t be a privilege of those who can afford it. We’re yet to see the “mental health revolution” David Cameron has talked about, but speaking with Mind and service providers, the government’s attitude to mental health is changing. Reports from the government and NHS often describe how they are striving for “parity of esteem” between mental and physical health (in other words, for them to hold the same level of importance).

If money was invested into improving prevention and early-stage support rather than continuing to fund the short-term quick-fix model that’s in place, and the reports written were followed up, then perhaps this parity of esteem would be reached. The Mental Health Taskforce and other mental health organisations have produced strong material showing the need for change and ways to implement it, it just comes down to the government’s ability to listen and then do.

*Interviewees requested to be kept anonymous.

Long-term counselling/psychotherapy services available in Bristol

FREE

  • Womankind: Up to six months psychodynamic therapy for women; no waiting list but you need to call up regularly to see if spaces have become available. Helpline: 0345 4582914 (free from mobiles) or 0117 916 6461; offers up to 50 minutes with a therapist; open Mon-Fri 10am-12pm, Mon & Tues 8-10pm, Tues & Wed 1-3pm.
  • Free Psychotherapy Network: A list of counsellors and psychotherapists offering free or reduced-rate therapy to people on low income or benefits in the UK.
  • Bristol Wellbeing Therapies (formerly LIFT Psychology): Six to 12 sessions, sometimes clients are offered another set of six or 12; long waiting lists (average of four months but can be more); can refer yourself or via your GP; after receiving treatment you can refer yourself again six months later if you need to.
  • Off the Record: Free mental health support for 18-25 year olds in Bristol.

LOW COST

  • Low Cost Counselling: Long term therapy; suggested fee of £12.50 a session, but you can pay more or less depending on your circumstances – they don’t want people turned away through lack of funds; no waiting list; counsellors come to your home but you can see a counsellor in a location nearby if preferred.
  • The Swan Project: Long term; £10 a session if unwaged, £15 waged; approx. two weeks wait for initial assessment; average six to eight week waiting list; specialise in addiction but work with anyone.
  • Network: Pay what you can counseling.

Pride against all odds

A culture of disbelief towards LGBT asylum seekers means the safety and acceptance provided by support groups like Bristol Pride Without Borders is vital.

“Bristol Pride Without Borders has given me back my dignity. I have not felt as safe in such a long time. Where I come from, being in a same-sex relationship is a taboo, and a criminal offence,” explains Amy*, a member of the Bristol Pride Without Borders (PWB) group. “If caught, you face mob violence. I was. I am fortunate to have lived.”

Amy’s experience is far from unique. Being LGBT+ is in many countries either illegal or a source of persecution, and the risks faced by LGBT+ people include death, imprisonment and violence. Sexual and gender identity is therefore one of many reasons people might be claiming asylum in the UK or elsewhere. There has been a more than 400% rise in people claiming asylum based on sexuality in the last five years – in the most recent figures released by the Home Office (from 2014), 1,115 people cited sexuality as their reason for seeking refuge, whereas in 2009 there were just 200 cases relating to sexuality, according to the website PinkNews.

To address the need for support systems for people in Bristol who are both asylum seekers and lesbian, gay, bisexual or transgender, Bristol PWB was set up in September 2015 by two local charities, Borderlands and Bristol Refugee Rights. The group has been meeting every two weeks since.

“It was needed because there was no safe space for LGBT+ refugees and asylum seekers where it was safe to be open about their identity and history. These people are exceptionally marginalised and we felt that the existing community groups were not meeting their needs,” says Tom Daly, who co-facilitates the group. “[Bristol PWB] provides a non-discriminatory and non-judgemental space for LGBT+ asylum seekers and refugees to talk about their experiences and feelings with people from a similar background.”

Bristol PWB has links with other local meetups such as walking group LGBT WalkOut and the self-explanatory LGBT Brunch, and keeps its members informed about opportunities to engage with their activities.

“Our coordinator is understanding, helpful, and has been very resourceful. We meet and share what we’ve each been doing. He has taken us to film shows, attended an AGM for LGBT Bristol, and joined others in a solidarity march and panel discussions to learn about the wider picture of human rights and LGBT rights,” says Amy.

“This group is for asylum seekers like me who come here with so many worries and problems, with a main one being how they will be received because of their sexual orientation. But with PWB we have been welcomed,” she adds. “Bristol PWB has given me back my dignity. I have not felt as safe in such a long time. For the first time I feel I can be myself as I share the friendship of others in my social group.”

The struggle for recognition

LGBT+ asylum seekers typically find the asylum process extremely difficult, with the Home Office using systematic barriers to deter and reject asylum claims made on the basis of sexual orientation.

“The asylum system is harsh and difficult for anyone to pass through, but for those people whose claim for protection is based on their sexual identity, it is doubly so,” says Daly. “Asylum seekers are rigorously questioned in an ordeal lasting between four and eight hours. The Home Office routinely refuse claims and demand that people prove their sexual orientation. As well as being humiliating and dehumanising to have to relay your personal life for scrutiny in a courtroom, it is also very hard to prove.”

The Home Office has changed its approach to assessing these claims in recent years. In 2010, a research report by UKLGIG (UK Lesbian and Gay Immigration Group, a charity promoting equality and dignity for LGBT+ people seeking asylum in UK) found 98-99% of asylum claims made by LGBT+ people were rejected in the first instance, compared with 73% of other asylum claims. Back then, the rejections were justified by the Home Office on the basis that people could return to their home country and “live in discretion and to have relationships in secret”, Daly explains.

Later the same year, it was finally acknowledged that this method of refusal was denying people Article 8 of the Human Rights Act — the right to a private and family life. It was also putting people in significant danger.

The Home Office mostly changed its tactic to asking people to “prove” that they are LGBT+, instead. Numbers of approvals have improved, with now roughly 60% of asylum seekers being refused at their first claim. Of those rejections, 90% of the time the Home Office says, “We accept that you have the right to live and express your sexuality, but we don’t believe you’re gay,” says Daly. “The Home Office must know they are refusing cases that are genuine, but it’s because they have this political motive to reduce immigration numbers.”

LBGT+ asylum seekers often find their stories are interpreted according to stereotypes and false assumptions from heterosexual officials. Further issues can be caused by the reliance on interpreters during questioning, who may come from the very community the individual is fleeing, leading the applicant to fear that they may harbour the same prejudices.

“Many of those who are initially refused are later recognised as refugees by a higher court after waiting several more years,” says Daly. For people to have to go to appeal, and have the court overturn the Home Office’s decision, is not only an incredibly stressful and lengthy process for the individuals, it’s also “a massive waste” of money and time, he adds.

“We are hopeful that more and more people will be granted at first instance – it would benefit everyone,” says Joey, an assistant at UKLGIG.

While waiting to be interviewed, asylum seekers are not allowed to work – “they are forced to wait and are blocked from integrating or contributing,” explains Daly. “They are housed in hostels where they share low quality housing and scrape by on £37 a week.”

These hostels aren’t always safe spaces for people to be either. “Being placed in a hostel with a bunch of people who are possibly holding discriminating beliefs from their country of origin is really stressful and often dangerous for people,” says Joey of UKLGIG. The organisation is working for safer accommodation for LGBT+ asylum seekers, and a less traumatic process for them to go through. In Berlin, meanwhile, the first-ever hostel specific to LGBT asylum seekers recently opened.

“We are positive things are changing, and we have already seen conditions improve – especially within the area of detention of LGBTQ+ asylum seekers – but there’s still a lot that needs to happen,” Joey adds.

Finding pride

For now, groups such as Bristol Pride Without Borders provide vital emotional support. As Amy points out, attending the group may be the first time a participant feels that they’re in a safe place, where they can relate to others without fear of judgement.

“People should know that LGBT asylum seekers are people who have been persecuted and are afraid,” says Amy. “Being open is a very new experience to us, but bit by bit we are getting used to it and liking it. We just need to be accepted without always having to answer questions or made to feel guilty because of who we are.”

“It is heartwarming to see how the members in this group look out for each other and the room is often filled with laughter,” says Daly. “We have spent hours talking about the challenges of reconciling sexual identity with religion and culture.”

“Nobody can be in my situation because everyone is different,” concludes Amy. “But if they need company they should join PWB.”

*Name has been changed.

If you are LGBT+ and an asylum seeker or refugee, and are interested in going to the group, please contact Tom Daly on 07856 672351 or tom@refugeerights.org for more details. The group meets every second Wednesday from 6pm-8pm.


Bristol projects breaking down borders

What do Bristolian social workers, herbalists, and circus performers have in common? Using their skills to to provide direct aid to refugees, in border zones and in the city.

Herbalists Without Borders, Bristol

“Setting up the migrant support clinic is a deeply rooted act of resistance against an unjust global political system that has created such unjust borders, as well as this government’s introduction of the new immigration bill which further isolates migrants,” says Becs Griffiths, co-founder of Herbalists Without Borders, Bristol (HWBB).

HWBB is a branch of Herbalists Without Borders UK. It is a collaboration between local clinical herbalists, herb growers, and the herb community of Bristol. Becs founded the group with Annwen Jones, the two having worked together at Rhizome Community Herbal Clinic.

“Homelessness, unstable housing, poverty,  loneliness and social isolation, and living in a constant state of uncertainty regarding their future and asylum status, are just some of the challenges migrants face daily,” says Becs. “Living in such extreme stress greatly impacts their health and wellbeing, by creating high levels of anxiety, insomnia, coughs, chest infections, and low immunity, amongst other more complex conditions.”

Herbal medicine is one of the most ancient forms of medicine. Using plants to create medicines, it’s based on the theory of addressing all dimensions of health – the physical, emotional, social, political, spiritual, and environmental – to treat a person holistically.

HWBB’s vision is to offer migrants access to a mobile herbal dispensary and drop-in sessions treating common ailments, and one-on-one consultations with qualified medical herbalists for individuals with more complex and/or chronic conditions. They also aim to provide self-care workshops that aim to improve general health and wellbeing, and teach basic herbal medicine, along with facilitating time spent in local community garden projects, growing and getting to know the herbs.

“Being part of a herbal growing project, making a connection to the local natural environment, and learning the tools of self-care are an important part in improving health and wellbeing,” says Becs.

HWBB have already collaborated with the Asylum Seeker Community Allotment (now New Roots Garden) and Unseen – a project that works directly with survivors of modern slavery and trafficking – and are working towards taking the mobile dispensary into other local projects working with asylum seekers and refugees in the spring.

They will also make medicine for projects working with refugees overseas, and hope that the project becomes a model that can be replicated in other areas of the UK, establishing a wider network of Herbalists Without Borders.

There are various ways you can be involved with HWBB. They host regular medicine making evenings, and need specific herbs grown and harvested for the project, amongst other things – email HWB.bristol@gmail.com if you’re interested in being involved.

You can also donate to their crowdfunder here, which ends on 26th January 2017.

Social Workers Without Borders

In March 2016, a small group of social workers started Social Workers Without Borders (SWWB), whose website states: “We believe that our social work skills and knowledge can be utilised to minimise risk and promote the rights and dignity of those affected by borders.”

Kate Grant, who co-founded the SWWB South West group, had worked with refugees and asylum seekers in Bristol and volunteered in Calais. “I could not believe the lack of compassion, care and the racism I was seeing for those attempting to secure a future for themselves. As a social worker I encounter situations everyday where I see the impact of the asylum process on individuals. I signed up to this profession because I wanted to support people – borders should not get in the way or exclude people who deserve access to care.”

“As a social worker I encounter situations everyday where I see the impact of the asylum process on individuals. I signed up to this profession because I wanted to support people – borders should not get in the way or exclude people who deserve access to care.”

SWWB currently organise several different projects. Last year they merged with another organisation, Social Work First, to provide direct social work response within the Calais “jungle” – maintaining a weekly presence at the camp. They helped with legal cases for children in the camp, have been lobbying local and national government, and have drawn up guidelines on how to assist safe passage for those seeking safety.

They also deliver social work education lectures, and advise professionals and potential foster carers on the specific needs of children affected by borders.

In Bristol, they work in partnership with community organising alliance Citizens UK in supporting unaccompanied asylum seeking children from camps in Europe to Bristol. They are also undertaking a research project with Bristol Refugee Rights to allow those who are “experts by experience” to share their experiences of trying to access support from social workers and social care professionals, to inform “a best practice guide” for practitioners on how to support people effectively.

“On a national level we hope to use our voices as social workers to campaign, lobby and raise awareness of the impact that borders have on the lives of others. We hope to bring a voice to the social work profession that recognises the arbitrary and unnecessary suffering that borders create,” explains Kate.

You can donate to SWWB here, and follow them on Twitter. Join the Facebook group or email socialworkerwithoutbordersuk@gmail.com if you are a social worker/social worker student and want to be involved with the project or set up your own regional group elsewhere in the country.

Circus To Borders

The Invisible Circus in Bristol has a Social Circus programme, known as The Invisible Youth, where circus is used as a platform for social change amongst young people and vulnerable groups. Circus To Borders (CTB) was formed out of this movement, working overseas in the Calais and Dunkirk refugee camps, and now in Belgrade, Serbia, where the situation is “atrocious” says Abi Hill, a member of CTB.

“It’s absolutely freezing. Tomorrow it will be -20. People are sleeping in parks in open air — it’s grim,” describes another of the CTB team, currently in Serbia. “It’s almost impossible to get out of Serbia so the number of refugees who enter Serbia is increasing everyday, and all the official camps are full.”

CTB try to have a presence in camps once a month. Abi and a group of others got back from Dunkirk last week. Helen, the manager of Dunkirk Children’s Centre, emailed them after their visit: “I just love seeing how animated the kids get when you come. They’re always so much happier. You bring a big light to a grey day…can’t wait to have the clowns with us again.”

Abi describes part of the power of practicing Social Circus and Play being the fact it is about “the journey of the learning rather than the end result”, as well as “delivering crucial life skills” and “engaging children with positive role models”.

“We also try to use our collective practical skills to fundraise, organise logistics, and deliver aid. The internationally recognised clown/circus thing means that we are instantly recognisable to all as non-threatening and playful, so we are able to access places and people more easily than if we weren’t clowns…”

When asked what challenges they’ve come up against whilst working within CTB, the list included: “deciding how to fairly distribute 3 bikes between 150 young people” and “having your heart broken over and over again by people’s stories.”

They pride themselves in being a small, grass-roots organisation, without a plan of where they want the project to go, and instead trying “to respond to the ever-developing situation in an intuitive manner”, explains Abi.

The majority of the CTB team is based in Bristol, so if you want to get involved, email: keeloverkate@gmail.com. “The best way for people to help is to mobilise and go to these places,” says Abi. “But financial donations also help.”

You can donate to their latest crowdfunder here.


The politics of mental health in Bristol

On Monday, the Freedom of Mind festival kicked off with a panel discussion on Bristol’s mental health services – and what we can do to make it better.

Teaming up with Festival of Ideas, the event in City Hall brought together a panel of politicians, councillors and advocates to tackle questions from youth mental health, to investment and cuts in services to the role of stigma in addressing mental health issues.

I sat among an almost-full house of listeners, 90% of whom were under 30. It was inspiring and comforting to be amongst such a high number of people my age, all there with the same interest and intention. It was also great to see such a higher number of men at the event.

Here are some of the highlights of the discussion…

Young People

Young people were discussed first, with Thangham Debbonaire MP explaining how the PSHE (Personal, Social, Health and Economic Education) on offer in schools is not adequate enough, and needs to be more student-led.

The rest of the panel echoed the need for this to be improved, and spoke of the need to keep mental health awareness and provision relevant to the challenges young people face today.

Councillors Fi Hance and Clare Campion-Smith both agreed that being a young person in today’s society holds more opportunities for intense emotional challenges than their generation experienced pointing, for example, to pressures from social media and the impact that can have on a person’s emotional wellbeing.

Early-intervention

Every panelist agreed that early intervention in mental health is what matters, and where current mental health services need to be more focused.

“The sooner you intervene, the better the outcome”, says Dr Dominique Thompson, director of Students’ Health Services at the University of Bristol. “Otherwise you are trying to come back from a more difficult foundation than if you’d have gotten involved earlier.” 

Early-stage intervention saves money and pressure on resources further down the line, however, the money saved doesn’t necessarily go back to the people who spent out the money in the first place.

“For example, for every pound spent on alcohol treatment of somebody you get something like £578 back within 5 years, but that money isn’t going back into the council budget, it’s going into the pocket of the NHS, so we need to find some way of the council and the NHS working together”, explains Hance.

Hance also spoke of the need to address waiting lists, where people can be stuck for months after they have taken the courage to reach out and ask for support. Dr Thompson also described how thousands of people “fall through the gaps”, because they are considered “complex” and the NHS’ limited model of 12 sessions of CBT/counselling can do more harm than good – an issue I’ve previously written about in the Cable.

There’s also the issue of continuity for those transitioning from child to adult services: “You fall off a cliff from child services into the adult mental health system”, explains Dr Thompson, who spends 90% of her time as Director of Students Health Services at the University of Bristol, dealing with mental health issues.

“Money saved [on early intervention] doesn’t necessarily go back to the people who spent out the money in the first place.”

Each panel member encouraged people to vote when the time comes. Government reports, full of promises and commitments to change, are written – but nobody makes sure the government delivers what they promised. If the government was held accountable, argued Dr Thompson, there could be fundamental change within the mental health system.

Chatting to Dr Thompson after the panel discussion, she explained that we need to elect a government that cares about peoples well being. “There are too many people in the current government who don’t”, she said.

Trans health

Cheryl Morgan, presenter on Ujima Radio and trans awareness trainer, was an inspiring speaker, describing her own personal experience, and that of people she has worked with during her time working within trans health. There are shockingly high statistics of self-harm and suicidality amongst the Trans community, yet “there are no gender services for people in Bristol – people have to go elsewhere”.

She shared her frustration about the NHS saying gender services are “too expensive”, despite the fact that (unlike other mental health services that are unavailable from the NHS in Bristol due to the services needing to be open-ended/long term, for example) gender services support someone over a set period of time, with 90% of Trans people reporting to feel better after that period of support.

Stigma and Mental Health

Stigma was also an important part of the evening’s discussion. The panel was in agreement that although there is not as much stigma as there used to be, with the younger generations having greater understanding of mental health difficulties and increased emotional literacy, stigma does still exist on a large scale.

Stigma can impact individuals in many different ways, from feeling and becoming isolated to self-harm and feeling suicidal. Another way it can impact someone is through their experience of trying to access support services in Bristol. “Someone might be ‘being the difficult person’”, Debbonaire described, “but we need to help them anyway.”

Another point raised was the ways that someone’s living situation can have a huge effect on someone’s mental health, for example the impact of homelessness or the strain caused by the housing crisis and unstable home environments.

“We need better communication between service providers – we need to tease out when housing providers need help from NHS professionals, for example,” explains Debbonaire. “Sadly, during this time of austerity, professionals often end up triaging – it becomes a case of, ‘who can I most help today’, instead of ‘who most needs my help today?’”

What can I do?

“If the government was held accountable there could be fundamental change within the mental health system.”

The evening ended with an excellent motivational speech from Ella Marshall, one of the co-founders of Freedom of Mind, in which she told us to “have conversations”: talk about your emotional wellbeing and share any challenges you are experiencing.

“We need to create a social change because it isn’t coming from the government”, explains Marshall. ‘Conversation, education, change’, is the phrase of the festival.

Better communication between government and local councils, and between service providers, was something that seemed to come up over and over again during the discussions. Debbonaire encouraged everyone, and young people especially, to write to your local politician/councillor about your experiences of the current mental health system.

On a wider scale, Dr Thompson talked about Sustainability and Transformation Plans. “Look them up, read about them, ask what’s happening with them, push back”, she said. “It’s all happening in secret and it’s not right.”

The political climate has a direct impact on our emotional well being. During this time of austerity it feels even more important to have sufficient mental health support within the city. Sadly, there is still a major lack of support available, but there is not a lack of people – because we have each other, we can support each other.

Check out the Freedom of Mind website for the events coming up over the next few days.